Federico Raveglia1*, Matilde De Simone3, Alessandro Rizzi1, Piero Di Mauro2, Alessandro Baisi1 and Ugo Cioffi3
1Department of Thoracic Surgery, University of Milan, Italy
2Department of Anesthesiology, University of Milan, Italy
3Department of Surgery, University of Milan, Italy
Objective: We have previously presented the successful results of paravertebral local analgesia in thoracotomy patients. Therefore, we have developed and described an intraoperative technique for paravertebral catheter (PC) placement and continuous local analgesic infusion in video assisted thoracic surgery (VATS). This innovative technique is different from the “lots of resistance”/blind or the ultrasound-guided placement procedures, besides continuous infusion work differently from paravertebral blocks. We present a randomized study comparing this procedure with opioid intravenous patient controlled analgesia (OIVPCA).Methods: From October to December 2015, 40 patients submitted to VATS lung resection have been randomized into two homogenous groups for the administration of analgesic drugs, through PC + OIVPCA (morphine 1 mg/1ml bolus, lock out 10 minutes) in “group A” or OIVPCA alone in “group B”. In “group A”, Tuhoy needle was percutaneously introduced below parietal pleura in the same intercostal space as the camera port. Insertion point was detected on the skin, 3 cm by the vertebral column. PC was pushed through the needle until paravertebral space was reached. Postoperative analgesia was performed by continuous infusion of local analgesic (naropine 3,75%, 7 ml/h). The following parameters have been recorded on scheduled postoperative days: a) pain control using visual analogue scale b) respiratory function using FEV1 and ambient air saturation c) morphine-equivalent demanded/administered. Records have been analyzed with Mann-Withney or Student's tests for independent variables.
Results: No complications in PC placement were recorded. Moreover, due to thoracoscopic approach posterior parietal pleura remained intact, unlike thoracotomy, avoiding any drug runoff in the pleural cavity. Significant differences have been found in favor of group A concerning both rest and cough pain control (p< 0.01 and 0.035) and respiratory function in terms of FEV1 (p=0.017). No difference was recorded concerning ambient air saturation (p >0.05). Group A had significant lower mean morphine-equivalent demanded (5.47 mg vs. 9 mg) and consumption (4.76 mg vs. 8.38 mg).Conclusion: Intra-operative PC placement was safe and easy to perform. Local analgesic paravertebral continuous infusion was effective and allowed lower morphine consumption. We strongly recommend this procedure in VATS to further improve thoracoscopy advantages in pain management.
Raveglia F, De Simone M, Rizzi A, Di Mauro P, Baisi A, Cioffi U. Paravertebral Continuous Infusion Analgesia in Vats Patients. Single Center Prospective Randomized Study. Clin Surg. 2016; 1: 1135.